Missouri Gov. Jay Nixon is renewing his push to expand Missouri's Medicaid health care program to cover more lower-income adults.

The Democratic governor said Tuesday that he hopes lawmakers who rejected a Medicaid expansion in 2013 will reconsider in 2014 as they see federal dollars start flowing to other states that have expanded eligibility.

Republican legislative leaders have said they are reluctant to expand eligibility without first overhauling the Medicaid program to make it more efficient and effective.

Nixon said he's open to many of those proposals, such as penalties for Medicaid patients who make unnecessary emergency room visits. He's also open to an expanded use of managed care policies.

States that expand Medicaid eligibility for adults can receive enhanced federal funding beginning in 2014.